augmented endoscopy

AUGMENTED
ENDOSCOPY
Giuseppe Galloro
University of Naples - School of Me
Dept. of Clinical Medicine and Sur
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Controversial point
Topic discussed for a long time
Flat and depressed lesions
Debated between western and eastern position
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Paris and Vienna symposia unified western an
eastern positions (endoscopic and pathologica
Nowadays we speak a common language
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SM 3
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Tools of the modern endoscopy
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TRADITIONAL
CRHOMO--ENDOSCOP
IN DIAGNOSIS OF
EARLY CRC
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Two endoscopic dyes
INDIGO CARMINE
CRESYL VIOLET
CONTRAST/CONTACT DYE
ROUGH MITOTIC INDEX
MINIMAL CHANGES EVALUATION
absorbed by Golgi organelles
actively proliferating cells
mucosal dyschromia (rednes,
palenes)
irregularity of sm vascular pattern
mucosal roughness
converging folds
erosions
Quantitative ratio
To identify shape, margins and size of the lesio
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Lee BE BMC Gastroen
Nagahama T Gastrointest En
To allow diagnosis according Paris classificatio
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peduncolated
flat-elevated
elevated
sessile
flat
depressed
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Quantitative ratio
Prognostic ratio
RELATIONSHIP BETWEEN SHAPE AND SIZE OF THE TUMOR AND
DEEP INFILTRATION RATE
ZOOM-ENDOSCOPY
ENDOSCOPY
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IN DIAGNOSIS OF
EARLY CRC
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Very important breakthrough of japanese scho
Explosive impact on endoscopic and clinical practice
COLON PIT PATTERN
ACCORDING KUDO
CLASSIFICATION
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PP 1
PP 4
PP 2
PP 5 i
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Qualitative ratio
Allows a differential diagnosis between
neoplastic, benign, and malignant lesions
PIT PATTERN
NON
NEOPLASTIC
ADENOMA
LGD
I - II ( n° 726)
( n° 504)
( n° 212)
( n° 10)
( n° 0)
( n° 0)
III l ( n° 8661)
( n° 267)
( n° 6278)
( n° 1751)
( n° 0)
( n° 365)
III s ( n° 285)
( n° 3)
( n° 167)
( n° 79)
( n° 11)
( n° 25)
IV ( n° 1971)
( n° 52)
( n° 1082)
( n° 395)
( n° 73)
( n° 369)
( n° 266)
( n° 0)
( n° 40)
( n° 64)
( n° 56)
( n° 106)
V n ( n° 195)
( n° 0)
( n° 0)
( n° 13)
( n° 128)
( n° 54)
Vi
ADENOMA
HGD
SM
MUSC
CARCINOMA CARCINOMA
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High agreement, in skilled hands, between
pattern and histological findings
FUJI T.
KIESSLICH R.
HIRATA M.
Gastrointest Endosc 2006
Br J Cancer 2010
Gastrointest Endosc 2011
82 - 92%
87 - 94%
96%
This agreement is different for the severa
pattern
IS GREATEST FOR PIT PATTERN 1 AND IV
IS LOWEST FOR PIT PATTERN I1 AND
COMPUTED VIRTUAL
CHROMOENDOSCOPY
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IN DIAGNOSIS OF
EARLY CRC
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“F the first step of early changing
cancerogenesis consists in angio-neogenesis
“F If we have a tool allowing the exploration o
superficial vascular net F then we could improve
diagnostic endoscopic performances F” Skinner J Dig D
Nowadays we have something like that
CVC allows an endoscopic evaluation
superficial sub-mucosal
mucosal vascular pattern
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i - scan
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CVC in diagnosis of early colorectal lesions
been studied very close
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105 papers in last 5 years
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CVC follows a learning curve
The technique is rapidly learned
Neumann H Gastrointest Endosc 2013
DIFFERENTIATION BETWEEN NEOPLASTIC AND NON NEOPLASTIC
COLORECTAL LESIONS
CVC ALONE
IS BETTER THAN
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WL ENDOSCOPY OR
CHROMOENDOSCOPY
Togashi K Gastrointest Endosc 200
CVC +
MAGNIFICATION
IS BETTER THAN
MAGNIFICATION
ALONE
Yamamoto H J Gastroenterol 201
DETECTION OF POLYPOID AND NON POLYPOID
COLORECTAL LESIONS
CVC ALONE
IS NOT SUPERIOR TO
WL ENDOSCOPY +
The most used classification is that by Kanao
and micro vessels, using NBI)
Kanao H Gastrointest End
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CLEAR PITS
NO OR OPAQUE M.V.
CLEAR PITS
FINE M.V. VIA THE PITS
IRREGULAR PITS
IRREGULAR M.V.
DIAMETER/DISTRIBUTION
IRREGULAR PITS
N
PITS NON WELL DISTINCT
IRREGULAR
M.V.
VIA
PITS
IRREGULA
IRREGULAR M.V. VIA PITS
DIAMETER/DISTRIBUTION
DIAMETER
AVASCU
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ZOOM - MAGNIFYING
ENDOSCOPY
TRADITIONAL
CHROMOENDOSCOPY
COMPUTED VIRTUAL
CHROMOENDOSCOPY
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LEADS TO AN INCREASE OF
ENDOSCOPIC PERFORMANCE
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ZOOM - MAGNIFYING
ENDOSCOPY
TRADITIONAL
CHROMOENDOSCOPY
COMBINATION
COMPUTED VIRTUAL
CHROMOENDOSCOPY
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ALLOWS FURTHER IMPROVEMENT OF
DIAGNOSTIC RESULTS
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Augmented endoscopy nowadays is a fact
Chromoendoscopy, magnification, and CVC are
new but present technologies
We have to know how to use them
We have to use them always in the diagn
colonoscopy
Augmented endoscopy racks should represent
standard instrumentation in all the endoscopic ce
and not just in dedicated-tertiary
dedicated
centers